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Debellut F, Gamage D, Kumar S, Wickramasinghe S, Ruwanpathirana T, Kariyawasam M, Perera CS, Ginige S, Cooray N, Pecenka C, Slavkovsky R, Scott LaMontagne D, Mvundura M. Human papillomavirus (HPV) vaccination program in Sri Lanka: Ongoing costs and operational context of a routinized program. Vaccine X 2024; 17:100456. [PMID: 38379668 PMCID: PMC10877402 DOI: 10.1016/j.jvacx.2024.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Existing evidence on the cost of human papillomavirus (HPV) vaccination programs has focused on pilot and demonstration projects or initial introductions, which resulted in a perceived high cost. We aimed to study the ongoing cost and operational context of an established HPV vaccination program in Sri Lanka. We conducted a retrospective operational research and microcosting study focusing on 2019. We collected data from 30 divisional health units, 10 districts, and the central level. We then evaluated financial and economic costs, reported by level of the health system, program activity, cost types, and per dose delivered. In 2019, Sri Lanka delivered a total of 314,815 doses of HPV vaccine. In our study sample, 95 % of the HPV vaccination sessions took place at schools, with peaks of delivery in February-March and September-October. The weighted mean financial cost per dose delivered was $0.27 (95 % confidence interval [CI]: $0.15-$0.39) and the economic cost per dose was $3.88 (95 % CI: $2.67-$5.10), excluding the cost of vaccines and supplies. Most of the cost was borne by the divisional health unit level. Service delivery and social mobilization were major contributors to overall costs at the divisional health unit level, and vaccine collection or distribution and storage were the most costly activities at the district and central levels. Cost drivers included the opportunity cost of health worker and non-health worker time at the divisional health unit level and capital costs for vehicles and equipment, along with fuel, maintenance, and energy, at the district and central levels. This study provides new evidence on the cost and cost drivers of a routinized HPV vaccination program. Results can be used for financial planning purposes in Sri Lanka and may inform other countries as they consider use of HPV vaccines.
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Affiliation(s)
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | | | | | | | | | | | | | | | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, USA
| | - Rose Slavkovsky
- Center for Vaccine Innovation and Access, PATH, Seattle, USA
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Malvolti S, Soble A, Bloem P, LaMontagne DS, Aggarwal R, Pitisuttithum P, Rees H, Cernuschi T. The Global Demand and Supply Balance of the Human Papillomavirus Vaccine: Implications for the Global Strategy for the Elimination of Cervical Cancer. Vaccines (Basel) 2023; 12:4. [PMID: 38276663 PMCID: PMC10820532 DOI: 10.3390/vaccines12010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024] Open
Abstract
As of November 2023, 140 World Health Organization (WHO) member states had introduced human papillomavirus (HPV) vaccination in their routine immunization schedules. Despite a continuously increasing demand from countries across all income groups, supply constraints, COVID-19 pandemic disruptions, and other factors have slowed the pace of introduction, particularly in low-resource settings. Using a population-based forecasting methodology and leveraging the WHO's yearly vaccine supply data collection, we updated global demand and supply projections for the HPV vaccine for the period of 2022-2031. The analysis aimed at clarifying the magnitude of the challenges to bringing in equitable access to HPV vaccines, which can hinder the achievement of the Global Strategy for the Elimination of Cervical Cancer. The results of this analysis show that the risk of HPV shortages has significantly decreased, and global supply is now, under normal circumstances, sufficient to meet global demand. In the long term, HPV supply will be more than sufficient to meet the Global Strategy's goal of 90% of girls fully vaccinated with the HPV vaccine by the age of 15 years. Nonetheless, paying attention to the formulation of policies and carefully managing demand and supply will be required to ensure the long-term sustainability of the HPV vaccine program.
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Affiliation(s)
| | - Adam Soble
- MMGH Consulting GmbH, 8049 Zurich, Switzerland;
| | - Paul Bloem
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 1202 Geneva, Switzerland; (P.B.); (T.C.)
| | | | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India;
| | | | - Helen Rees
- Wits RHI, University of Witwatersrand, Johannesburg 2001, South Africa;
| | - Tania Cernuschi
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 1202 Geneva, Switzerland; (P.B.); (T.C.)
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Bruni L, Saura-Lázaro A, Montoliu A, Brotons M, Alemany L, Diallo MS, Afsar OZ, LaMontagne DS, Mosina L, Contreras M, Velandia-González M, Pastore R, Gacic-Dobo M, Bloem P. Corrigendum to "HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010-2019" [Preventive Medicine 144 (2021) 106399]. Prev Med 2022; 155:106925. [PMID: 34998610 DOI: 10.1016/j.ypmed.2021.106925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laia Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain.
| | - Anna Saura-Lázaro
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain
| | - Alexandra Montoliu
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain
| | - Maria Brotons
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Mamadou Saliou Diallo
- Data and Analytics Unit, Department of Analysis, Planning & Monitoring, UNICEF, New York, USA
| | - Oya Zeren Afsar
- Maternal, Neonatal & Adolescent Health Unit, Health Section, UNICEF, New York, USA
| | | | - Liudmila Mosina
- Division of Country Health Programmes, Vaccine-preventable Diseases and Immunization (VPI), World Health Organization Regional Office for the Europe, Copenhagen, Denmark
| | - Marcela Contreras
- Comprehensive Family Immunization Unit, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
| | - Martha Velandia-González
- Comprehensive Family Immunization Unit, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
| | - Roberta Pastore
- Division of Country Health Programmes, Vaccine-preventable Diseases and Immunization (VPI), World Health Organization Regional Office for the Europe, Copenhagen, Denmark
| | - Marta Gacic-Dobo
- Immunization Analysis & Insights Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Paul Bloem
- Life Course and Integration/ EPI, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Vodicka E, Nonvignon J, Antwi-Agyei KO, Bawa J, Clark A, Pecenka C, LaMontagne DS. The projected cost-effectiveness and budget impact of HPV vaccine introduction in Ghana. Vaccine 2021; 40 Suppl 1:A85-A93. [PMID: 34303563 DOI: 10.1016/j.vaccine.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cervical cancer is responsible for around one-quarter of all cancer deaths among Ghanaian women. Between 2013 and 2015, Ghana conducted a pilot of HPV vaccination among 10-14-year-old girls in four regions; however, the country has yet to introduce the vaccine nationally. This study projected the cost-effectiveness and budget impact of adding HPV vaccination into Ghana's national immunization program. METHODS We used a proportional outcomes model (UNIVAC, version 1.4) to evaluate the cost-effectiveness of introduction with bivalent (Cervarix™) and quadrivalent (Gardasil®) vaccines from government and societal perspectives. Vaccine introduction was modeled to start in 2022 and continue over ten birth cohorts using a combined delivery strategy of school (80%) and community outreach (20%). We modeled vaccination in a single age cohort of 9-year-old girls vs. a multi-age cohort of 9-year-old girls (routine) and 10-14-year-old girls (one-time campaign) compared to no vaccination. Health outcomes included cervical cancer cases, hospitalizations, deaths, and disability-adjusted life years (DALYs). We applied a discount rate of 3% to costs and outcomes. All monetary units are reported in USD 2018. RESULTS National HPV vaccination in Ghana was projected to be cost-effective compared to no vaccination in all scenarios evaluated. The most cost-effective and dominant strategy was vaccination among 9-year-old girls, plus a one-time campaign among 10-14-year-old with the bivalent vaccine ($158/DALY averted from the government perspective; 95% credible range: $19-$280/DALY averted). Projected average annual costs of the vaccine program ranged from $11.2 to $15.4 M, depending on strategy. This represents 11-15% of the estimated total immunization costs for 2022 ($100,857,875 based on Ghana's comprehensive Multi-Year Plan for Immunization, 2020-2024). DISCUSSION Our model suggests that introducing HPV vaccination would be cost-effective in Ghana under any strategy when willingness-to-pay is at least 40% GDP per capita ($881). Inclusion of a one-time catch-up campaign is shown to create greater value for money than routine immunization alone but would incur greater program costs.
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Affiliation(s)
| | - Justice Nonvignon
- University of Ghana, Department of Health Policy, Planning and Management, P.O Box LG 78, Legon, Accra, Ghana
| | | | - John Bawa
- PATH-Ghana, 14a Ameda Street, Roman Ridge, Accra, Ghana
| | - Andrew Clark
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Clint Pecenka
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98109, USA
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LaMontagne DS, Manangazira P, Marembo J, Chigodo C, Zvamashakwe C, Tshuma E, Marima E, Chindedza K, Ndlela E, Mooney J. HPV vaccination coverage in three districts in ZIMBABWE following national introduction of 0,12 month schedule among 10 to 14 year old girls. Vaccine 2021; 40 Suppl 1:A58-A66. [PMID: 34275674 DOI: 10.1016/j.vaccine.2021.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/16/2021] [Accepted: 07/06/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Zimbabwe has one of the highest incidence rates of cervical cancer in the world - 61.7 per 100,000 women. The government of Zimbabwe introduced bivalent HPV vaccine with a 0,12 month schedule to all 10-14 year old girls using a pulsed-campaign approach in May 2018 (dose 1) and May 2019 (dose 2). METHODS In August 2019, we conducted a population-based, two-stage cluster survey of households with girls who were eligible for the national HPV vaccination program to determine two-dose HPV vaccination coverage in three districts of Zimbabwe. All households with girls currently aged 11 to 15 years were line-listed through a census conducted in the pre-selected clusters from each district prior to survey administration. A simple random sample of eligible households was selected from these lists to estimate HPV vaccine coverage at sufficient power with a margin of error of +/- 5%. Criteria for district selection included estimated vaccine uptake (low, medium, high), rural/urban/peri-urban, geographic area, estimated number of girls not in school, and recent natural disasters or disease outbreaks. We oversampled households with girls aged 13 or 14 years at the time of dose 1. RESULTS On-time dose 1 uptake ranged from 88 to 94% and two-dose HPV vaccine coverage ranged from 75 to 86% across the three districts. Nearly all vaccinations occurred in schools, and less than 2% of girls did not attend school. There were challenges assessing ages of girls at schools prior to vaccination - 9% of girls vaccinated were less than 10 years old at time of dose 1. DISCUSSION Zimbabwe has demonstrated that high uptake and successful completion of 2-dose HPV vaccination can be achieved with an annual dosing schedule. Efforts going forward will need to focus on minimizing dropout between doses and routinizing annual vaccinations in schools for every subsequent new cohort of eligible girls in the country.
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Affiliation(s)
- D Scott LaMontagne
- PATH, Center for Vaccine Innovation & Access, 2201 Westlake Avenue, Suite 200, Seattle, WA, USA.
| | - Portia Manangazira
- Ministry of Health and Child Care, Epidemiology and Disease Control, Harare, Zimbabwe
| | - Joan Marembo
- Ministry of Health and Child Care, Expanded Programme on Immunization, Harare, Zimbabwe
| | - Colline Chigodo
- Ministry of Health and Child Care, Expanded Programme on Immunization, Harare, Zimbabwe
| | - Coscar Zvamashakwe
- Ministry of Health and Child Care, Expanded Programme on Immunization, Harare, Zimbabwe
| | - Emma Tshuma
- Ministry of Health and Child Care, Expanded Programme on Immunization, Harare, Zimbabwe
| | - Evelyn Marima
- Zimbabwe National Statistics Agency, Harare, Zimbabwe
| | - Kenneth Chindedza
- World Health Organization, Zimbabwe Country Office, Harare, Zimbabwe.
| | | | - Jessica Mooney
- PATH, Center for Vaccine Innovation & Access, 2201 Westlake Avenue, Suite 200, Seattle, WA, USA.
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Tsu VD, LaMontagne DS, Atuhebwe P, Bloem PN, Ndiaye C. National implementation of HPV vaccination programs in low-resource countries: Lessons, challenges, and future prospects. Prev Med 2021; 144:106335. [PMID: 33678232 PMCID: PMC7957340 DOI: 10.1016/j.ypmed.2020.106335] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023]
Abstract
More than 90% of cervical cancer deaths occur in low- and middle-income countries (LMICs), which have limited capacity to mount the comprehensive national screening and precancer treatment programs that could prevent most of these deaths. The development of vaccines against the human papillomavirus (HPV) has dramatically altered the landscape of cervical cancer prevention. As of mid-2020, 56 LMICs (41% of all LMICs) have initiated national HPV vaccination programs. This paper reviews the experience of LMICs that have introduced HPV vaccine into their national programs, key lessons learned, HPV vaccination sustainability and scale-up challenges, and future mitigation measures. As international guidance evolved and countries accumulated experience, strategies for national introduction shifted with regard to target groups, delivery site and timing, preparation and planning, communications and social mobilization, and ultimately monitoring, supervision and evaluation. Despite the successes that LMICs have been able to achieve in reaching large proportions of eligible girls, there are still considerable challenges countries encounter in overcoming rumors, reaching out-of-school girls, completing the vaccine series, estimating target populations, monitoring program performance, and assuring vaccination sustainability. New opportunities, such as the entry of additional vaccine manufacturers and ongoing studies to evaluate one-dose delivery, could help overcome the outstanding barriers to higher coverage and financial sustainability. Effective use of the experience to date and advances on the horizon could enable all LMICs to move towards the coverage levels that are needed to achieve eventual elimination.
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Affiliation(s)
| | | | - Phionah Atuhebwe
- Africa Regional Office, World Health Organization, Brazzaville, Congo.
| | - Paul N Bloem
- Life Course and Integration/EPI, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
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Anwari P, Debellut F, Vodicka E, Clark A, Farewar F, Zhwak ZA, Nazary D, Pecenka C, Scott LaMontagne D, Safi N. Potential health impact and cost-effectiveness of bivalent human papillomavirus (HPV) vaccination in Afghanistan. Vaccine 2020; 38:1352-1362. [PMID: 31870571 PMCID: PMC6997884 DOI: 10.1016/j.vaccine.2019.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) vaccination has not been introduced in many countries in South-Central Asia, including Afghanistan, despite the sub-region having the highest incidence rate of cervical cancer in Asia. This study estimates the potential health impact and cost-effectiveness of HPV vaccination in Afghanistan to inform national decision-making. METHOD An Excel-based static cohort model was used to estimate the lifetime costs and health outcomes of vaccinating a single cohort of 9-year-old girls in the year 2018 with the bivalent HPV vaccine, compared to no vaccination. We also explored a scenario with a catch-up campaign for girls aged 10-14 years. Input parameters were based on local sources, published literature, or assumptions when no data was available. The primary outcome measure was the discounted cost per disability-adjusted life-year (DALY) averted, evaluated from both government and societal perspectives. RESULTS Vaccinating a single cohort of 9-year-old girls against HPV in Afghanistan could avert 1718 cervical cancer cases, 125 hospitalizations, and 1612 deaths over the lifetime of the cohort. The incremental cost-effectiveness ratio was US$426 per DALY averted from the government perspective and US$400 per DALY averted from the societal perspective. The estimated annual cost of the HPV vaccination program (US$3,343,311) represents approximately 3.53% of the country's total immunization budget for 2018 or 0.13% of total health expenditures. CONCLUSION In Afghanistan, HPV vaccine introduction targeting a single cohort is potentially cost-effective (0.7 times the GDP per capita of $586) from both the government and societal perspective with additional health benefits generated by a catch-up campaign, depending on the government's willingness to pay for the projected health outcomes.
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Affiliation(s)
- Palwasha Anwari
- Afghanistan National Immunization Technical Advisory Group, District 10, Kabul, Afghanistan
| | | | | | - Andrew Clark
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Farhad Farewar
- Health Economics and Financing Directorate, Ministry of Public Health, Masood Square, District 10, Kabul, Afghanistan
| | - Zubiada A Zhwak
- Kabul University of Medical Sciences "Abu Ali Ibn Sina", Jamal Mena, University Area, District 3, Kabul, Afghanistan
| | - Dastagger Nazary
- Expanded Program on Immunization, Ministry of Public Health, Street 13, Wazir Akbar Khan, District 10, Kabul, Afghanistan
| | - Clint Pecenka
- PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA
| | | | - Najibullah Safi
- World Health Organization, UNOCA Compound, Jalalabad Road, District 9, Kabul, Afghanistan
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de Sanjose S, Brotons M, LaMontagne DS, Bruni L. Human papillomavirus vaccine disease impact beyond expectations. Curr Opin Virol 2019; 39:16-22. [DOI: 10.1016/j.coviro.2019.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/14/2022]
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Nguyen DTN, Hughes S, Egger S, LaMontagne DS, Simms K, Castle PE, Canfell K. Risk of childhood mortality associated with death of a mother in low-and-middle-income countries: a systematic review and meta-analysis. BMC Public Health 2019; 19:1281. [PMID: 31601205 PMCID: PMC6788023 DOI: 10.1186/s12889-019-7316-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background Death of a mother at an early age of the child may result in an increased risk of childhood mortality, especially in low-and-middle-income countries. This study aims to synthesize estimates of the association between a mother’s death and the risk of childhood mortality at different age ranges from birth to 18 years in these settings. Methods Various MEDLINE databases, EMBASE, and Global Health databases were searched for population-based cohort and case-control studies published from 1980 to 2017. Studies were included if they reported the risk of childhood mortality for children whose mother had died relative to those whose mothers were alive. Random-effects meta-analyses were used to pool effect estimates, stratified by various exposures (child’s age when mother died, time since mother’s death) and outcomes (child’s age at risk of child death). Results A total of 62 stratified risk estimates were extracted from 12 original studies. Childhood mortality was associated with child’s age at time of death of a mother and time since a mother’s death. For children whose mother died when they were ≤ 42 days, the relative risk (RR) of dying within the first 1–6 months of the child’s life was 35.5(95%CI:9.7–130.5, p [het] = 0.05) compared to children whose mother did not die; by 6–12 months this risk dropped to 2.8(95%CI:0.7–10.7). For children whose mother died when they were ≤ 1 year, the subsequent RR of dying in that year was 15.9(95%CI:2.2–116.1,p [het] = 0.02), compared to children whose mother lived. For children whose mother died when they were ≤ 5 years of age, the RR of dying before aged 12 was 4.1(95%CI:3.0–5.7),p [het] = 0.83. Mortality was also elevated in specific analysis among children whose mother died when child was older than 42 days. Overall, for children whose mother died < 6 and 6+ months ago, RRs of dying before reaching adulthood (≤18 years) were 4.7(95%CI:2.6–8.7,p [het] = 0.2) and 2.1(95%CI:1.3–3.4,p [het] = 0.7), respectively, compared to children whose mother lived. Conclusions There is evidence of an association between the death of a mother and childhood mortality in lower resource settings. These findings emphasize the critical importance of women in family outcomes and the importance of health care for women during the intrapartum and postpartum periods and throughout their child rearing years. Electronic supplementary material The online version of this article (10.1186/s12889-019-7316-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diep Thi Ngoc Nguyen
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia.,Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Suzanne Hughes
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia
| | - Sam Egger
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia
| | | | - Kate Simms
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia
| | - Phillip E Castle
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, USA
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, Sydney, NSW, 2011, Australia. .,Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia. .,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
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Gallagher KE, Howard N, Kabakama S, Mounier-Jack S, Burchett HED, LaMontagne DS, Watson-Jones D. Human papillomavirus (HPV) vaccine coverage achievements in low and middle-income countries 2007-2016. ACTA ACUST UNITED AC 2017; 4:72-78. [PMID: 29179873 PMCID: PMC5710977 DOI: 10.1016/j.pvr.2017.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 12/15/2022]
Abstract
Introduction Since 2007, HPV vaccine has been available to low and middle income countries (LAMIC) for small-scale ‘demonstration projects’, or national programmes. We analysed coverage achieved in HPV vaccine demonstration projects and national programmes that had completed at least 6 months of implementation between January 2007–2016. Methods A mapping exercise identified 45 LAMICs with HPV vaccine delivery experience. Estimates of coverage and factors influencing coverage were obtained from 56 key informant interviews, a systematic published literature search of 5 databases that identified 61 relevant full texts and 188 solicited unpublished documents, including coverage surveys. Coverage achievements were analysed descriptively against country or project/programme characteristics. Heterogeneity in data, funder requirements, and project/programme design precluded multivariate analysis. Results Estimates of uptake, schedule completion rates and/or final dose coverage were available from 41 of 45 LAMICs included in the study. Only 17 estimates from 13 countries were from coverage surveys, most were administrative data. Final dose coverage estimates were all over 50% with most between 70% and 90%, and showed no trend over time. The majority of delivery strategies included schools as a vaccination venue. In countries with school enrolment rates below 90%, inclusion of strategies to reach out-of-school girls contributed to obtaining high coverage compared to school-only strategies. There was no correlation between final dose coverage and estimated recurrent financial costs of delivery from cost analyses. Coverage achieved during joint delivery of HPV vaccine combined with another intervention was variable with little/no evaluation of the correlates of success. Conclusions This is the most comprehensive descriptive analysis of HPV vaccine coverage in LAMICs to date. It is possible to deliver HPV vaccine with excellent coverage in LAMICs. Further good quality data are needed from health facility based delivery strategies and national programmes to aid policymakers to effectively and sustainably scale-up HPV vaccination.
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Affiliation(s)
- Katherine E Gallagher
- London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.
| | - Natasha Howard
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
| | - Sandra Mounier-Jack
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - Helen E D Burchett
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Keppel St, London WC1E 7HT, United Kingdom
| | - D Scott LaMontagne
- PATH, Center for Vaccine Innovation and Access, PO Box 900922, Seattle, WA 98109, United States
| | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
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LaMontagne DS, Bloem PJ, Brotherton JM, Gallagher KE, Badiane O, Ndiaye C. Progress in HPV vaccination in low- and lower-middle-income countries. Int J Gynaecol Obstet 2017; 138 Suppl 1:7-14. [DOI: 10.1002/ijgo.12186] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Julia M.L. Brotherton
- National HPV Vaccination Program Register; VCS Ltd; Melbourne Vic. Australia
- School of Population and Global Health; University of Melbourne; Melbourne Victoria Australia
| | | | - Ousseynou Badiane
- Division de l'Immunisation; Ministère de la Santé et de l'Action Sociale; Dakar Senegal
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Howard N, Gallagher KE, Mounier-Jack S, Burchett HED, Kabakama S, LaMontagne DS, Watson-Jones D. What works for human papillomavirus vaccine introduction in low and middle-income countries? ACTA ACUST UNITED AC 2017; 4:22-25. [PMID: 29179865 PMCID: PMC5710981 DOI: 10.1016/j.pvr.2017.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/31/2017] [Accepted: 06/03/2017] [Indexed: 11/29/2022]
Abstract
Since 2007, low and middle-income countries (LMICs) have gained experience delivering HPV vaccines through HPV vaccination pilots, demonstration projects and national programmes. This commentary summarises lessons from HPV vaccination experiences in 45 LMICs and what works for HPV vaccination introduction. Methods included a systematic literature review, unpublished document review, and key informant interviews. Data were extracted from 61 peer-reviewed articles, 11 conference abstracts, 188 technical reports, and 56 interviews, with quantitative data analysed descriptively and qualitative data analysed thematically. Key lessons are described under five themes of preparation, communications, delivery, coverage achievements, and sustainability. Lessons learnt were generally consistent across countries and projects and sufficient lessons have been learnt for countries to deliver HPV vaccine through phased national rollout rather than demonstration projects. However, challenges remain in securing the political will and financial resources necessary to implement successful national programmes.
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Affiliation(s)
- Natasha Howard
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Katherine E Gallagher
- London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.
| | - Sandra Mounier-Jack
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Helen E D Burchett
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.
| | - D Scott LaMontagne
- PATH, Center for Vaccine Innovation and Access, PO Box 900922, Seattle, WA 98109, USA.
| | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, Clinical Research Department, Keppel St, London WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania.
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Kabakama S, Gallagher KE, Howard N, Mounier-Jack S, Burchett HED, Griffiths UK, Feletto M, LaMontagne DS, Watson-Jones D. Social mobilisation, consent and acceptability: a review of human papillomavirus vaccination procedures in low and middle-income countries. BMC Public Health 2016; 16:834. [PMID: 27543037 PMCID: PMC4992325 DOI: 10.1186/s12889-016-3517-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/16/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Social mobilisation during new vaccine introductions encourages acceptance, uptake and adherence to multi-dose schedules. Effective communication is considered especially important for human papillomavirus (HPV) vaccine, which targets girls of an often-novel age group. This study synthesised experiences and lessons learnt around social mobilisation, consent, and acceptability during 55 HPV vaccine demonstration projects and 8 national programmes in 37 low and middle-income countries (LMICs) between January 2007 and January 2015. METHODS A qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews. Data were extracted and analysed thematically. Additionally, first-dose coverage rates were categorised as above 90 %, 90-70 %, and below 70 %, and cross-tabulated with mobilisation timing, message content, materials and methods of delivery, and consent procedures. RESULTS All but one delivery experience achieved over 70 % first-dose coverage; 60 % achieved over 90 %. Key informants emphasized the benefits of starting social mobilisation early and actively addressing rumours as they emerged. Interactive communication with parents appeared to achieve higher first-dose coverage than non-interactive messaging. Written parental consent (i.e., opt-in), though frequently used, resulted in lower reported coverage than implied consent (i.e., opt-out). Protection against cervical cancer was the primary reason for vaccine acceptability, whereas fear of adverse effects, exposure to rumours, lack of project/programme awareness, and schoolgirl absenteeism were major reasons for non-vaccination. CONCLUSIONS Despite some challenges in obtaining parental consent and addressing rumours, experiences indicated effective social mobilisation and high HPV vaccine acceptability in LMICs. Social mobilisation, consent, and acceptability lessons were consistent across world regions and HPV vaccination projects/programmes. These can be used to guide HPV vaccination communication strategies without additional formative research.
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Affiliation(s)
- Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
| | - Katherine E. Gallagher
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH UK
| | - Helen E. D. Burchett
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH UK
| | - Ulla K. Griffiths
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH UK
| | - Marta Feletto
- PATH, Vaccine Access and Delivery, PO Box 900922, Seattle, WA 98109 USA
| | | | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
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LaMontagne DS, Fenton KA, Pimenta JM, Catchpole M, Rogers PA, Randall S, Hewitt WG, Mallinson H, Underhill GS, McLean L, Gleave T, Harindra V, Ghosh AK, Tobin JM. Using chlamydia positivity to estimate prevalence: evidence from the Chlamydia Screening Pilot in England. Int J STD AIDS 2016; 16:323-7. [PMID: 15899088 DOI: 10.1258/0956462053654249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies have suggested that positivity can be used to estimate the prevalence of Chlamydia trachomatis in large-scale chlamydia screening programmes. A recent pilot of opportunistic screening in England estimated that the prevalence among 16–24-year-old women in Portsmouth and Wirral was 9.8% and 11.2%, respectively. This study assessed the continued validity of positivity as an approximate for prevalence. We re-analysed data from the Chlamydia Screening Pilot to estimate positivity, calculated as total positive tests divided by total tests, and compared these estimates with the previously reported prevalence, measured as the number of women testing positive divided by the total number of women screened. Overall positivity was 9.4% in Portsmouth and 11.0% in the Wirral; these estimates were not statistically different from prevalence, regardless of health-care setting, age group or symptoms. We conclude that positivity can be used as a proxy for prevalence.
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Affiliation(s)
- D S LaMontagne
- Health Protection Agency, Communicable Disease Surveillance Centre, HIV and STI Department, 61 Colindale Avenue, London NW9 5EQ, UK.
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Howard N, Mounier-Jack S, Gallagher KE, Kabakama S, Griffiths UK, Feletto M, LaMontagne DS, Burchett HED, Watson-Jones D. The value of demonstration projects for new interventions: The case of human papillomavirus vaccine introduction in low- and middle-income countries. Hum Vaccin Immunother 2016; 12:2475-7. [PMID: 27159786 PMCID: PMC5027708 DOI: 10.1080/21645515.2016.1178433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Demonstration projects or pilots of new public health interventions aim to build learning and capacity to inform country-wide implementation. Authors examined the value of HPV vaccination demonstration projects and initial national programmes in low-income and lower-middle-income countries, including potential drawbacks and how value for national scale-up might be increased. Data from a systematic review and key informant interviews, analyzed thematically, included 55 demonstration projects and 8 national programmes implemented between 2007-2015 (89 years' experience). Initial demonstration projects quickly provided consistent lessons. Value would increase if projects were designed to inform sustainable national scale-up. Well-designed projects can test multiple delivery strategies, implementation for challenging areas and populations, and integration with national systems. Introduction of vaccines or other health interventions, particularly those involving new target groups or delivery strategies, needs flexible funding approaches to address specific questions of scalability and sustainability, including learning lessons through phased national expansion.
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Affiliation(s)
- N Howard
- a London School of Hygiene and Tropical Medicine , Department of Global Health and Development , Tavistock Place, London , UK
| | - S Mounier-Jack
- a London School of Hygiene and Tropical Medicine , Department of Global Health and Development , Tavistock Place, London , UK
| | - K E Gallagher
- b London School of Hygiene and Tropical Medicine , Clinical Research Department , Keppel St, London , UK.,c Mwanza Intervention Trials Unit, National Institute for Medical Research , Mwanza , Tanzania
| | - S Kabakama
- c Mwanza Intervention Trials Unit, National Institute for Medical Research , Mwanza , Tanzania
| | - U K Griffiths
- a London School of Hygiene and Tropical Medicine , Department of Global Health and Development , Tavistock Place, London , UK
| | - M Feletto
- d PATH, Vaccine Access and Delivery , Seattle , WA , USA
| | - D S LaMontagne
- d PATH, Vaccine Access and Delivery , Seattle , WA , USA
| | - H E D Burchett
- a London School of Hygiene and Tropical Medicine , Department of Global Health and Development , Tavistock Place, London , UK
| | - D Watson-Jones
- b London School of Hygiene and Tropical Medicine , Clinical Research Department , Keppel St, London , UK.,c Mwanza Intervention Trials Unit, National Institute for Medical Research , Mwanza , Tanzania
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Mugisha E, LaMontagne DS, Katahoire AR, Murokora D, Kumakech E, Seruyange R, Tsu VD. Feasibility of delivering HPV vaccine to girls aged 10 to 15 years in Uganda. Afr Health Sci 2015; 15:33-41. [PMID: 25834528 DOI: 10.4314/ahs.v15i1.5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cancer is a leading cause of mortality among women in Uganda. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. The Government of Uganda conducted a demonstration project exploring the feasibility of two delivery strategies. OBJECTIVE To explore the feasibility of two HPV vaccine delivery strategies: 1) a stand-alone school-based strategy that selected girls based on their enrolment in grade 5 (known as the "grade-based" strategy; and 2) an age-based strategy that delivered the HPV vaccine based on the girls' age (10-year-olds). This strategy combined the delivery of the vaccine with the distribution of deworming medication and vitamin A through an existing Child Days Plus program. METHODS A qualitative study that explored the feasibility of the two delivery strategies from the perspective of health workers, district leaders, and staff of the Uganda National Expanded Programme on Immunization, utilizing in-depth interviews and focus group discussions. RESULTS Coverage data showed that more girls (88%) were vaccinated using the grade-based strategy and completed all three doses compared to those (73%) vaccinated using the age-based strategy. Health workers and teachers indicated that determining vaccination eligibility was easier by grade than by age and there were minor disruptions to health services and school programs during vaccinations, as reported by health workers and teachers using the grade-based strategy. CONCLUSION HPV vaccine delivery at schools using grade eligibility was more feasible than selecting girls by age. Lessons learned in Uganda could be relevant for countries considering implementing HPV vaccinations.
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LaMontagne DS, Nghi NQ, Nga LT, Janmohamed A, Huyen DTT, Hien NT, Tsu VD. Qualitative study of the feasibility of HPV vaccine delivery to young adolescent girls in Vietnam: evidence from a government-implemented demonstration program. BMC Public Health 2014; 14:556. [PMID: 24898950 PMCID: PMC4067078 DOI: 10.1186/1471-2458-14-556] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 05/30/2014] [Indexed: 11/21/2022] Open
Abstract
Background Introduction of human papillomavirus (HPV) vaccine in national programs has proceeded apace since 2006, mostly in high-income countries. Recently concluded pilots of HPV vaccination in low-income countries have provided important lessons learned for these settings; however, rigorous evaluations of the feasibility of these delivery strategies that effectively reach young adolescents have been few. This paper presents results from a qualitative evaluation of a demonstration program which implemented school-based and health center–based HPV vaccinations to all girls in grade 6, or 11 years of age, for two years in four districts of Vietnam. Methods Using semi-structured interviews of 131 health and education staff from local, district, province, and national levels and 26 focus-group discussions with local project implementers (n = 153), we conducted a qualitative two-year evaluation to measure the impact of HPV vaccinations on the health and education systems. Results HPV vaccine delivery at schools or health centers was made feasible by: a. close collaboration between the health and education sectors, b. detailed planning for implementation, c. clearly defined roles and responsibilities for project implementers, d. effective management and supervision of vaccinations during delivery, and e. engagement with community organizations for support. Both the health and education systems were temporarily challenged with the extra workload, but the disruptions were short-lived (a few days for each of three doses) and perceived as worth the longer-term benefit of cervical cancer prevention. Conclusion The learning from Vietnam has identified critical elements for successful vaccine delivery that can provide a model for other countries to consider during their planning of national rollout of HPV vaccine.
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Affiliation(s)
- D Scott LaMontagne
- Vaccine Access & Delivery Department, PATH, PO Box 900922, Seattle, WA 98109, USA.
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Jain KM, Paul P, LaMontagne DS. Monitoring adverse events following immunisation in developing countries: experience from human papillomavirus vaccination demonstration projects. Sex Health 2013; 10:57-63. [PMID: 23237538 DOI: 10.1071/sh11161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 08/20/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surveillance of adverse events following immunisation (AEFIs) is important for maintaining trust in vaccination. This paper discusses retrospective reports by parents and guardians of girls experiencing AEFIs during human papillomavirus (HPV) vaccine demonstration projects in Uganda and Vietnam. METHODS A secondary analysis of data from a population-based survey measuring HPV vaccine coverage of eligible girls and acceptability among parents and guardians was conducted. Survey data from parents were analysed for frequency and type of AEFI and actions taken. RESULTS Of the 1700 eligible households contacted, all responded to the survey; of those, 1313 respondents had an eligible child who had received at least one dose of the HPV vaccine. Data were missing from 49 respondents, resulting in 1264 surveys. Twenty-five percent reported an AEFI, with fever (29.1%) and pain or swelling at the injection site (62.0%) being the most common. Events totalled 386 (10.5%) of the 3684 doses administered. Most parents reported that they took no action (63.9%) or cared for girls at home (16.1%) following an AEFI. Thirty-three parents sought advice from health workers or attended a clinic for 46 events (0.8% of all doses). Frequency of reporting varied by respondent identity, geographic location and vaccination location. CONCLUSIONS AEFIs reported were similar to Phase III vaccine trials. Most parents reporting AEFIs took no action or treated the girl at home, suggesting that most AEFIs were not serious enough to contact the health system. AEFI reports were more frequent when solicited in surveys compared with reports from routine monitoring.
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Affiliation(s)
- Kriti M Jain
- Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
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Levin CE, Van Minh H, Odaga J, Rout SS, Ngoc DNT, Menezes L, Araujo MAM, LaMontagne DS. Delivery cost of human papillomavirus vaccination of young adolescent girls in Peru, Uganda and Viet Nam. Bull World Health Organ 2013; 91:585-92. [PMID: 23940406 DOI: 10.2471/blt.12.113837] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate the incremental delivery cost of human papillomavirus (HPV) vaccination of young adolescent girls in Peru, Uganda and Viet Nam. METHODS Data were collected from a sample of facilities that participated in five demonstration projects for hpv vaccine delivery: school-based delivery was used in Peru, Uganda and Viet Nam; health-centre-based delivery was also used in Viet Nam; and integrated delivery, which involved existing health services, was also used in Uganda. Microcosting methods were used to guide data collection on the use of resources (i.e. staff, supplies and equipment) and data were obtained from government, demonstration project and health centre administrative records. Delivery costs were expressed in 2009 United States dollars (US$). Exclusively project-related expenses and the cost of the vaccine were excluded. FINDINGS The economic delivery cost per vaccine dose ranged from US$ 1.44 for integrated outreach in Uganda to US$ 3.88 for school-based delivery in Peru. In Viet Nam, the lowest cost per dose was US$ 1.92 for health-centre-based delivery. Cost profiles revealed that, in general, the largest contributing factors were project start-up costs and recurrent personnel costs. The delivery cost of HPV vaccine was higher than published costs for traditional vaccines recommended by the Expanded Programme on Immunization (EPI). CONCLUSION The cost of delivering HPV vaccine to young adolescent girls in Peru, Uganda and Viet Nam was higher than that for vaccines currently in the EPI schedule. The cost per vaccine dose was lower when delivery was integrated into existing health services.
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Affiliation(s)
- Carol E Levin
- Department of Global Health, University of Washington, Seattle, WA 98104, USA.
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Galagan SR, Paul P, Menezes L, LaMontagne DS. Influences on parental acceptance of HPV vaccination in demonstration projects in Uganda and Vietnam. Vaccine 2013; 31:3072-8. [PMID: 23684835 DOI: 10.1016/j.vaccine.2013.04.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/03/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
This study investigates the effect of communication strategies on human papillomavirus (HPV) vaccine uptake in HPV vaccine demonstration projects in Uganda and Vietnam. Secondary analysis was conducted on data from surveys of a representative sample of parents and guardians of girls eligible for HPV vaccine, measuring three-dose coverage achieved in demonstration projects in 2008-2010. Univariate and multivariate logistic regression analysis calculated the unadjusted and adjusted odds of receiving at least one dose of HPV vaccine depending on exposure to community influencers; information, education, and communication (IEC) channels; and demographic factors. This study found that exposure to community influencers was associated with HPV vaccine uptake in a multivariate model controlling for other factors. Exposure to non-interactive IEC channels was only marginally associated with HPV vaccine uptake. These results underscore the need of HPV vaccine programs in low- and middle-income countries to involve and utilize key community influencers and stakeholders to maximize HPV vaccine uptake.
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Affiliation(s)
- Sean R Galagan
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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Paul P, LaMontagne DS, Le NT. Knowledge of cervical cancer and HPV vaccine post- vaccination among mothers and daughters in Vietnam. Asian Pac J Cancer Prev 2013; 13:2587-92. [PMID: 22938425 DOI: 10.7314/apjcp.2012.13.6.2587] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited human papillomavirus (HPV) related knowledge might be a barrier to future vaccine acceptance. From 2008-2010, PATH conducted an HPV vaccination demonstration project in partnership with the government immunization program in Vietnam, which included awareness campaigns prior to vaccination. OBJECTIVE To assess and compare knowledge and attitudes about cervical cancer and HPV vaccines between mothers and daughters, and whether knowledge was associated with vaccination status. METHODS We analyzed HPV-related knowledge and attitude data from mother-daughter paired responses to a cross-sectional household survey. After parents completed the survey, daughters were asked the same questions. We calculated the frequency of responses for each question and devised a scaled composite measure for knowledge. RESULTS Participants believed they had received enough information about cervical cancer and HPV vaccines and it was sufficient to make a decision about vaccination. Fifty percent of the participants knew HPV causes cervical cancer and 80% knew the HPV vaccine prevented cervical cancer. Mothers had more knowledge about cervical cancer and HPV infection (p<0.01), compared to daughters, who had more vaccine specific knowledge (p<0.01). However, the total mean knowledge score was similar for the groups. Girls not fully vaccinated had a lower mean knowledge score than fully vaccinated girls (p<0.001). CONCLUSIONS Our results suggest that the purpose of the HPV vaccine was clearly messaged; however, some misconceptions about cervical cancer and HPV still exist. Limited knowledge about the magnitude of cervical cancer, HPV as a cause of cervical cancer, and HPV vaccines may have contributed to incomplete vaccination.
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Affiliation(s)
- Proma Paul
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Steben M, Jeronimo J, Wittet S, LaMontagne DS, Ogilvie G, Jensen C, Smith J, Franceschi S. Upgrading Public Health Programs for Human Papillomavirus Prevention and Control is Possible in Low- and Middle-income Countries. Vaccine 2012. [DOI: 10.1016/j.vaccine.2012.06.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Objective and Method Cervical cancer is the third most common cancer affecting women worldwide and it is an important cause of death, especially in developing countries. Cervical cancer is caused by human papillomavirus (HPV) and can be prevented by HPV vaccine. The challenge is to expand vaccine availability to countries where it is most needed. In 2008 Peru’s Ministry of Health implemented a demonstration project involving 5th grade girls in primary schools in the Piura region. We designed and conducted a qualitative study of the decision-making process among parents of girls, and developed a conceptual model describing the process of HPV vaccine acceptance. Results We found a nonlinear HPV decision-making process that evolved over time. Initially, the vaccine’s newness, the requirement of written consent, and provision of information were important. If information was sufficient and provided by credible sources, many parents accepted the vaccine. Later, after obtaining additional information from teachers, health personnel, and other trusted sources, more parents accepted vaccination. An understanding of the issues surrounding the vaccine developed, parents overcome fears and rumors, and engaged in family negotiations–including hearing the girl’s voice in the decision-making process. The concept of prevention (cancer as danger, future health, and trust in vaccines) combined with pragmatic factors (no cost, available at school) and the credibility of the offer (information in the media, recommendation of respected authority figure) were central to motivations that led parents to decide to vaccinate their daughters. A lack of confidence in the health system was the primary inhibitor of vaccine acceptance. Conclusions Health personnel and teachers are credible sources of information and can provide important support to HPV vaccination campaigns.
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Affiliation(s)
| | | | - Mary E. Penny
- Instituto de Investigación Nutricional, La Molina, Lima, Peru
| | - D. Scott LaMontagne
- PATH, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Harborview Medical Center, Seattle, Washington, United States of America
- * E-mail:
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Cover JK, Nghi NQ, LaMontagne DS, Huyen DTT, Hien NT, Nga LT. Acceptance patterns and decision-making for human papillomavirus vaccination among parents in Vietnam: an in-depth qualitative study post-vaccination. BMC Public Health 2012; 12:629. [PMID: 22877158 PMCID: PMC3437216 DOI: 10.1186/1471-2458-12-629] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 08/03/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The GAVI Alliance's decision in late 2011 to invite developing countries to apply for funding for human papillomavirus (HPV) vaccine introduction underscores the importance of understanding levels of HPV vaccine acceptance in developing country settings. In this paper, we present findings from qualitative research on parents' rationales for vaccinating or not vaccinating their daughters (vaccine acceptance) and their decision-making process in the context of an HPV vaccination demonstration project in Vietnam (2008-2009). METHODS We designed a descriptive qualitative study of HPV vaccine acceptability among parents of girls eligible for vaccination in four districts of two provinces in Vietnama. The study was implemented after each of two years of vaccinations was completed. In total, 133 parents participated in 16 focus group discussions and 27 semi-structured interviews. RESULTS Focus group discussions and in-depth interviews with parents of girls vaccinated revealed that they were generally very supportive of immunization for disease prevention and of vaccinating girls against HPV. The involvement of the National Expanded Program of Immunization in the demonstration project lent credibility to the HPV vaccine, contributing to high levels of acceptance. For parents who declined participation, concerns about side effects, the possibility that the vaccine was experimental, and the possible impact of the vaccine on future fertility rose to the surface. In terms of the decision-making process, many parents exhibited 'active decision-making,' reaching out to friends, family, and opinion leaders for guidance prior to making their decision. CONCLUSION Vietnam's HPV vaccination experience speaks to the importance of close collaboration with the government to make the most of high levels of trust, and to reduce suspicions about new vaccines that may arise in the context of vaccine introduction in developing country settings.
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Affiliation(s)
| | - Nguyen Quy Nghi
- PATH, Unit 01-02, Floor 2nd, Hanoi Towers, 49 Hai Ba Trung, Hoan Kiem District, Vietnam
| | | | - Dang Thi Thanh Huyen
- National Institute of Hygiene and Epidemiology, Ministry of Health, 1 Yersin St, Hanoi, Vietnam
| | - Nguyen Tran Hien
- National Institute of Hygiene and Epidemiology, Ministry of Health, 1 Yersin St, Hanoi, Vietnam
| | - Le Thi Nga
- PATH, Unit 01-02, Floor 2nd, Hanoi Towers, 49 Hai Ba Trung, Hoan Kiem District, Vietnam
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Affiliation(s)
- Vivien Davis Tsu
- Both authors are with the Reproductive Health Global Program, PATH, Seattle, WA
| | - D. Scott LaMontagne
- Both authors are with the Reproductive Health Global Program, PATH, Seattle, WA
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LaMontagne DS, Barge S, Le NT, Mugisha E, Penny ME, Gandhi S, Janmohamed A, Kumakech E, Mosqueira NR, Nguyen NQ, Paul P, Tang Y, Minh TH, Uttekar BP, Jumaan AO. Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries. Bull World Health Organ 2011; 89:821-830B. [PMID: 22084528 PMCID: PMC3209730 DOI: 10.2471/blt.11.089862] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. METHODS Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. FINDINGS Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. CONCLUSION High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.
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LaMontagne DS, Barge S, Le NT, Mugisha E, Penny M, Gandhi S, Janmohamed A, Kumakech E, Mosqueira NR, Nguyen NQ, Paul P, Tang Y, Minh TH, Uttekar BP, Jumaan A. Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries. Bull World Health Organ 2011. [DOI: 10.2471/blt.11.08986] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Penny M, Bartolini R, Mosqueira NR, LaMontagne DS, Mendoza MA, Ramos I, Winkler JL, Villafana J, Janmohamed A, Jumaan AO. Strategies to vaccinate against cancer of the cervix: Feasibility of a school-based HPV vaccination program in Peru. Vaccine 2011; 29:5022-30. [DOI: 10.1016/j.vaccine.2011.04.078] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 04/05/2011] [Accepted: 04/21/2011] [Indexed: 01/05/2023]
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Neuzil KM, Canh DG, Thiem VD, Janmohamed A, Huong VM, Tang Y, Diep NTN, Tsu V, LaMontagne DS. Immunogenicity and reactogenicity of alternative schedules of HPV vaccine in Vietnam: a cluster randomized noninferiority trial. JAMA 2011; 305:1424-31. [PMID: 21486975 DOI: 10.1001/jama.2011.407] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Human papillomavirus (HPV) vaccine programs may decrease the morbidity and mortality due to cervical cancer seen among women in low-resource countries. However, the 3-dose schedule over a 6-month period is a potential barrier to vaccine introduction in such settings. OBJECTIVE To determine the immunogenicity and reactogenicity of different dosing schedules of quadrivalent HPV vaccine in adolescent girls in Vietnam. DESIGN, SETTING, AND PARTICIPANTS Open-label, cluster randomized, noninferiority study (conducted between October 2007 and January 2010) assessing 4 schedules of an HPV vaccine delivered in 21 schools to 903 adolescent girls (aged 11-13 years at enrollment) living in northwestern Vietnam. INTERVENTION Intramuscular injection of 3 doses of quadrivalent HPV vaccine delivered on a standard dosing schedule (at 0, 2, and 6 months) and 3 alternative dosing schedules (at 0, 3, and 9 months; at 0, 6, and 12 months; or at 0, 12, and 24 months). MAIN OUTCOME MEASURES Serum anti-HPV geometric mean titers (GMT) measured 1 month after the third dose of the HPV vaccine was administered; GMT was determined by type-specific competitive immunoassay. Noninferiority of each alternative vaccination dosing schedule was achieved if the lower bound of the multiplicity-adjusted confidence interval (CI) of the type-specific GMT ratio for HPV-16 and HPV-18 was greater than 0.5 (primary outcome). Safety outcomes were immediate reactions, local reactions, fever within 7 days after each dose, and serious adverse events up to 30 days following the last dose. RESULTS In the intention-to-treat analysis, 809 girls who received at least 1 HPV vaccine dose had valid serum measurements 1 month after the third dose. After the third dose, the GMTs for those in the standard schedule group who received doses at 0, 2, and 6 months were 5808.0 (95% CI, 4961.4-6799.0) for HPV-16 and 1729.9 (95% CI, 1504.0-1989.7) for HPV-18; 5368.5 (95% CI, 4632.4-6221.5) and 1502.3 (95% CI, 1302.1-1733.2), respectively, for those whose received doses at 0, 3, and 9 months; 5716.4 (95% CI, 4876.7-6700.6) and 1581.5 (95% CI, 1363.4-1834.6), respectively, for those who received doses at 0, 6, and 12 months; and 3692.5 (95% CI, 3145.3-4334.9) and 1335.7 (95% CI, 1191.6-1497.3), respectively, for those who received doses at 0, 12, and 24 months. Noninferiority criteria were met for the alternative schedule groups that received doses at 0, 3, and 9 months (HPV-16 GMT ratio: 0.92 [95% CI, 0.71-1.20]; HPV-18 GMT ratio: 0.87 [95% CI, 0.68-1.11]) and at 0, 6, and 12 months (HPV-16 GMT ratio: 0.98 [95% CI, 0.75-1.29]; HPV-18 GMT ratio: 0.91 [95% CI, 0.71-1.17]). Prespecified noninferiority criteria were not met for the alternative schedule group that received doses at 0, 12, and 24 months (HPV-16 GMT ratio: 0.64 [95% CI, 0.48-0.84]; HPV-18 GMT ratio: 0.77 [95% CI, 0.62-0.96]). Pain at the injection site was the most common adverse event. CONCLUSIONS Among adolescent girls in Vietnam, administration of the HPV vaccine on standard and alternative schedules was immunogenic and well tolerated. The use of 2 alternative dosing schedules (at 0, 3, and 9 months and at 0, 6, and 12 months) compared with a standard schedule (at 0, 2, and 6 months) did not result in inferior antibody concentrations. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00524745.
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Bartolini RM, Drake JK, Creed-Kanashiro HM, Díaz-Otoya MM, Mosqueira-Lovón NR, Penny ME, Winkler JL, LaMontagne DS, Bingham A. Formative research to shape HPV vaccine introduction strategies in Peru. Salud Publica Mex 2010; 52:226-33. [PMID: 20485886 DOI: 10.1590/s0036-36342010000300007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 03/04/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To understand the sociocultural environment, health systems' capacities, and policy processes related to cervical cancer and HPV vaccines in order to inform HPV vaccine introduction. MATERIAL AND METHODS Mixed-method formative research using qualitative and quantitative data collection techniques. Participants included girls, parents, community leaders, health and education officials, and policymakers. RESULTS Respondents, including policymakers, generally supported HPV vaccine introduction, due partly to appreciation for the benefits of vaccination and the desire to prevent cancer. Community-level concerns regarding safety and quality of services will need to be addressed. The immunization system in Peru is strong and has capacity for including the HPV vaccine. CONCLUSION Formative research provides key insights to help shape an effective program for HPV vaccine introduction.
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Jacob M, Mawar N, Menezes L, Kaipilyawar S, Gandhi S, Khan I, Patki M, Bingham A, LaMontagne DS, Bagul R, Katendra T, Karandikar N, Madge V, Chaudhry K, Paranjape R, Nayyar A. Assessing the Environment for Introduction of Human Papillomavirus Vaccine in India~!2009-10-20~!2010-02-02~!2010-04-06~! ACTA ACUST UNITED AC 2010. [DOI: 10.2174/1875035401003010096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Biellik R, Levin C, Mugisha E, LaMontagne DS, Bingham A, Kaipilyawar S, Gandhi S. Health systems and immunization financing for human papillomavirus vaccine introduction in low-resource settings. Vaccine 2009; 27:6203-9. [PMID: 19698808 DOI: 10.1016/j.vaccine.2009.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 07/22/2009] [Accepted: 08/02/2009] [Indexed: 10/20/2022]
Abstract
This descriptive qualitative study synthesizes health system and immunization financing assessments performed through formative research in India, Peru, Uganda, and Vietnam using a non-probability sample of national and sub-national stakeholders; and recommends appropriate and effective strategies for HPV vaccine delivery in low-resource settings. We conclude that maximum feasibility and acceptability and lowest cost for delivering HPV vaccine can be achieved by implementing through national immunization programs; by partnering with other sectors, such as education and maternal-child health; by strengthening existing human resources and cold chain infrastructures where needed; and finally, by considering schools for reaching the target population.
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Tsui J, LaMontagne DS, Levin C, Bingham A, Menezes L. Policy Development for Human Papillomavirus Vaccine Introduction in Low-Resource Settings. ACTA ACUST UNITED AC 2009. [DOI: 10.2174/1875035400902010113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
OBJECTIVES (1) To synthesize sociocultural results from diverse populations related to vaccine decision-making, understanding of cervical cancer and its etiology, experience with previous vaccinations, human papillomavirus (HPV) vaccine concerns, and information needed to foster acceptance; (2) to contextualize findings in light of recent studies; and (3) to discuss implications for communication strategies to facilitate vaccine acceptance. DESIGN Descriptive qualitative synthesis of sociocultural studies in 4 countries using iterative theme-based analyses. SETTING Four developing countries: India, Peru, Uganda, and Vietnam. PARTICIPANTS Criterion-based sample of 252 focus-group discussions and 470 in-depth interviews with children, parents, teachers/administrators, health workers/managers, and community/religious leaders. A knowledge, attitudes, and practices survey was administered to 879 children and 875 parents in Vietnam. RESULTS We found that vaccine decision-making was primarily done by parents, with children having some role. Understanding of cervical cancer and HPV was limited; however, the gravity of cancer and some symptoms of cervical cancer were recognized. Vaccination and government-sponsored immunization programs were generally supported by respondents. Sentiments toward cervical cancer vaccines were positive, but concerns about quality of delivery, safety, adverse effects, and the effect on fertility were raised. Communities requested comprehensive awareness-raising and health education to address these concerns. CONCLUSION Sociocultural studies help elucidate the complexities of introducing a new vaccine from the perspective of children, parents, and communities. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the program locally relevant.
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Katahoire RA, Jitta J, Kivumbi G, Murokora D, Arube WJ, Siu G, Arinaitwe L, Bingham A, Mugisha E, Tsu V, LaMontagne DS. An assessment of the readiness for introduction of the HPV vaccine in Uganda. Afr J Reprod Health 2008; 12:159-172. [PMID: 19435020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Formative research assessing human papillomavirus (HPV) vaccine readiness in Uganda was conducted in 2007. The objective was to generate evidence for government decision-making and operational planning for HPV vaccine introduction. Qualitative research methods with children, parents, teachers, community leaders, health workers, technical experts and political leaders were used to capture understanding of socio-cultural, health system and policy environments. We found low levels of knowledge about cervical cancer and HPV. Vaccination and its benefits were well-understood; respondents were positive about HPV vaccination. Health systems were deemed adequate for HPV vaccine delivery. Schools were identified as a vaccination venue, given high attendance by girls aged 10-12 years. Communication and advocacy strategies to foster acceptance should provide information on cervical cancer, HPV vaccine safety, and side effects. Policymakers requested further detail on costs. Introduction of HPV vaccine could be integrated into existing reproductive health and immunization policies.
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Affiliation(s)
- R A Katahoire
- Child Health and Development Centre, Makerere University Medical School, P.O. Box 6717, Kampala, Uganda
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Affiliation(s)
- Sarah Randall
- Ella Gordon Unit, St Mary's Hospital, Portsmouth, UK.
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LaMontagne DS, Pimenta JM, Fenton KA, Mallinson H, Hopwood J. Management of genital chlamydial infections at termination of pregnancy services in England and Wales: where are we now? BJOG 2005; 111:1408-12. [PMID: 15663127 DOI: 10.1111/j.1471-0528.2004.00207.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the range of policies and practices related to the management of genital chlamydial infection employed at termination of pregnancy services in England and Wales. DESIGN Cross-sectional descriptive study. SETTING England and Wales. POPULATION Termination of pregnancy providers. METHODS Survey questionnaire administered to termination of pregnancy providers. MAIN OUTCOME MEASURES Policies and practices for the management of genital chlamydial infection in women seeking termination of pregnancy with comparison to the national guidelines of the chief medical officer (CMO) and the Royal College of Obstetricians and Gynaecologists (RCOG). RESULTS One hundred and thirty-eight (48%) practices responded to the survey, with representation across England and Wales. Policies for screening and/or treatment of chlamydial infection existed for 70% of providers. We found three practice patterns for the management of genital chlamydial infection among termination of pregnancy attenders: 70% of providers tested their own attenders prior to termination and treated if necessary; about 25% of providers administered prophylaxis without testing; and a small number of providers (< 5%) neither tested nor treated attenders. CONCLUSION These patterns may be the result of differences in the CMO and RCOG guidelines. Given the impact of untreated genital chlamydial infection in women attending for termination, consistent recommendations from the CMO and RCOG may encourage uniform practice for the management of chlamydial infection in this vulnerable population.
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Affiliation(s)
- D Scott LaMontagne
- HIV/STI Department, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
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LaMontagne DS, Fenton KA, Randall S, Anderson S, Carter P. Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening. Sex Transm Infect 2004; 80:335-41. [PMID: 15459399 PMCID: PMC1744892 DOI: 10.1136/sti.2004.012856] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The phased implementation of the National Chlamydia Screening Programme (NCSP) began in September 2002. The NCSP offers opportunistic screening for chlamydia to women and men under 25 years of age attending clinical and non-clinical screening venues using non-invasive urine or vulvo-vaginal swab samples tested via nucleic acid amplification. This review describes the implementation of the NCSP, reports positivity rates for the first year, and explores risk factors for genital chlamydial infection. METHODS Cross sectional study of the first year's screening data from the NCSP. A standardised core dataset for each screening test was collected from 302 screening venues, excluding genitourinary medicine (GUM) clinics, across 10 phase 1 programme areas. We estimated chlamydia positivity by demographic and behavioural characteristics, and investigated factors associated with infection through univariate and multivariate analyses. RESULTS Chlamydia positivity among people under 25 years of age screened in non-GUM settings was 10.1% (1538/15 241) in women and 13.3% (156/1172) in men. Risk factors varied by sex: for women-age 16-19, non-white ethnicity, and sexual behaviours were associated with infection; for men-only age 20-24 and non-white ethnicity were associated with infection. DISCUSSION In the first phase of the NCSP, 16 413 opportunistic screens among young adults under 25 years of age were performed at non-GUM settings and testing volume increased over time. Rates of disease were similar to those found during the English screening pilot and were comparable to the first year of widespread screening in Sweden and the United States. The screening programme in England will continue to expand as further phases are included, with national coverage anticipated by 2008.
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Affiliation(s)
- D S LaMontagne
- HIV and Sexually Transmitted Infections Department, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.
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Adams EJ, LaMontagne DS, Johnston AR, Pimenta JM, Fenton KA, Edmunds WJ. Modelling the healthcare costs of an opportunistic chlamydia screening programme. Sex Transm Infect 2004; 80:363-70. [PMID: 15459403 PMCID: PMC1744903 DOI: 10.1136/sti.2004.009654] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To estimate the average cost per screening offer, cost per testing episode and cost per chlamydia positive episode for an opportunistic chlamydia screening programme (including partner management), and to explore the uncertainty of parameter assumptions, based on the costs to the healthcare system. METHODS A decision tree was constructed and parameterised using empirical data from a chlamydia screening pilot study and other sources. The model was run using baseline data from the pilot, and univariate and multivariate sensitivity analyses were conducted. RESULTS The total estimated cost for offering screening over 12 months to 33,215 females aged 16-24 was 493,412 pounds . The average cost (with partner management) was 14.88 pounds per screening offer (90% credibility interval (CI) 10.34 to 18.56), 21.83 pounds per testing episode (90% CI 18.16 to 24.20), and 38.36 pounds per positive episode (90% CI 33.97 to 42.25). The proportion of individuals accepting screening, the clinician (general practitioner/nurse) time and their relative involvement in discussing screening, the test cost, the time to notify patients of their results, and the receptionist time recruiting patients had the greatest impact on the outcomes in both the univariate and multivariate sensitivity analyses. CONCLUSIONS Results from this costing study may be used to inform resource allocation for current and future chlamydia screening programme implementation.
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Affiliation(s)
- E J Adams
- Statistics, Modelling and Economics Department, Communicable Disease Surveillance Centre, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK.
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Brown AE, Sadler KE, Tomkins SE, McGarrigle CA, LaMontagne DS, Goldberg D, Tookey PA, Smyth B, Thomas D, Murphy G, Parry JV, Evans BG, Gill ON, Ncube F, Fenton KA. Recent trends in HIV and other STIs in the United Kingdom: data to the end of 2002. Sex Transm Infect 2004; 80:159-66. [PMID: 15169995 PMCID: PMC1744850 DOI: 10.1136/sti.2004.009571] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sexual health in the United Kingdom has deteriorated in recent years with further increases in HIV and other sexually transmitted infections (STIs) reported in 2002. This paper describes results from the available surveillance data in the United Kingdom from the Health Protection Agency and its national collaborators. The data sources range from voluntary reports of HIV/AIDS from clinicians, CD4 cell count monitoring, a national census of individuals living with HIV, and the Unlinked Anonymous Programme, to statutory reports of STIs from genitourinary medicine (GUM) clinics and enhanced STI surveillance systems. In 2002, an estimated 49500 adults aged over 15 years were living with HIV in the United Kingdom, of whom 31% were unaware of their infection. Diagnoses of new HIV infections have doubled from 1997 to 2002, mainly driven by heterosexuals who acquired their infection abroad. HIV transmission also continues within the United Kingdom, particularly among homo/bisexual men who, in 2002, accounted for 80% of all newly diagnosed HIV infections acquired in the United Kingdom. New diagnoses of syphilis have increased eightfold, and diagnoses of chlamydia and gonorrhoea have doubled from 1997 to 2002 overall; STI rates disproportionately affect homo/bisexual men and young people. Effective surveillance is essential in the provision of timely information on the changing epidemiology of HIV and other STIs; this information is necessary for the targeting of prevention efforts and through providing baseline information against which progress towards targets can be monitored.
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Affiliation(s)
- A E Brown
- HIV and STI Department, Health Protection Agency, Communicable Disease Surveillance Centre, UK.
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LaMontagne DS, Catchpole M, Fenton K. British Chief Medical Officer recommendations for genital chlamydial infection screening may not be applicable outside the UK. J Med Screen 2004; 10:210; reply 210-1. [PMID: 14738660 DOI: 10.1258/096914103771773339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
BACKGROUND The epidemiology of Chlamydia trachomatis infection in men is not well defined, especially among those who are asymptomatic or show no signs of infection. Established C. trachomatis screening programs for women have demonstrated the benefit of routine screening in reducing prevalence over time, but the yield and benefit of screening asymptomatic men are unclear. METHODS Cross-sectional study of C. trachomatis prevalence and associated risk factors among men tested at sexually transmitted disease (STD) clinics in Alaska, Idaho, Oregon, and Washington. We analyzed data from 43,094 men universally tested from 1997 to 1999 at 103 STD clinics, and assessed age-specific prevalence of infection, controlling for signs of infection (urethritis diagnosed by clinician) and report of sexual contact to a person with an STD (defined as "contact"). RESULTS Overall prevalence of C. trachomatis was 10.3%. Age-specific prevalence was highest among men aged 18 to 19 years and lowest among those aged >29 years, regardless of signs of infection upon examination or contact to a person with an STD. If these factors and age <25 years had been used to direct C. trachomatis testing at STD clinics, 59% of men would have been tested and 91% of positives would have been detected. CONCLUSIONS Using either the presence of clinical signs or report of a sex partner with an STD in combination with selective screening of all men aged <25 years detects the majority of infections and, in our population, would have considerably reduced the number of negative tests performed.
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